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Adopting With Care, and for Good

A decade ago, the doctor peered at grainy videos, trying to glean a sense of the future from an out-of-focus present. Now, she’s more likely to sit at her computer, click on an e-mail message, and view crisper footage taken on a Flip camera: a toddler waving a stuffed animal, a baby lying passively in a crib.

Those early moments could become part of a family’s history, or they might be erased, cleared out to make way for those of some other child. Is the baby making eye contact? Is he alert? What the doctor notes about these far-from-home videos, she knows, may determine the fate of the family, and the fate of a child in desperate need of one.

Dr. Jane Aronson is a long-distance diagnostician based in New York, one of a handful of specialized pediatricians across the country who help aspiring parents determine the emotional or physical health of a child whom they’re considering adopting.

Torry Hansen, the Tennessee mother now infamous for sending her 7-year-old adopted son back to Russia, seemed to think the decision of whether to parent a child raised in an orphanage could be made at any point in the relationship. But for the vast majority of adoptive parents, that decision, a sometimes torturous one, is made long before the child sets foot on American soil.

“Even if I give parents a referral with what I call an average risk, meaning there are no medical red flags, I find people struggle tremendously,” said Dr. Aronson. “They feel that they don’t have enough information. And they’re scared.”

Dr. Aronson sends parents off to meet their prospective children overseas with a list of questions, some of them painful to consider: Have you connected with the child? Are you afraid of this child? Is there something about the way the child looks that makes you scared?

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Dr. Jane Aronson examined a 14-month-old, Paul Thomas Shih, in her Manhattan office on Thursday. Paul was brought home from China two weeks ago by his adoptive parents, Philip and Susan Shih.Credit
Ramin Talaie for The New York Times

She draws a firm line at advising parents whether or not to move forward; she tries instead to give whatever medical insight she can, and then help parents trust their own intuition about how much risk they can handle, or the kinds of potential challenges they’re prepared to take on. She frequently asks parents to repeat back to her what they’ve heard her say in her medical analysis; what she hears back often reveals a level of denial she feels obliged to penetrate, even knowing what it may mean for the child. “That piece haunts me,” she said.

As people start building momentum for the great leap of faith that adoption entails, friends often remind them that no pregnant mother can predict her child’s future — that the decision to parent is always a decision to embrace messiness, to relinquish the notion of control.

There may be no more visible advocate for overseas adoption than Dr. Aronson, but that particular assurance is not one she espouses. An American baby born to a mother with good prenatal care, she pointed out, is not facing the same risk as, say, an Ethiopian orphan, who is much more likely to have been exposed to malnutrition in utero. Every three months in even a good orphanage, Dr. Aronson said, is thought to delay development, at least temporarily, by one month.

To insist on the parity in risk, then, is to deny the remarkable capacity for unblinking love that so many adoptive parents seem to have, an openness they’ve either carried through their lives or developed over years of longing.

Thursday morning, Philip and Susan Shih, parents in their 40s who live in Cranford, N.J., watched with fierce pride as their 14-month-old, Paul — their son of two weeks, adopted from a Chinese orphanage — moved beads on a toy in Dr. Aronson’s office.

They looked attentive but unconcerned as Dr. Aronson pointed out that Paul’s teeth were chalky, possibly from poor nutrition. Around his legs, two strips of discoloration reflected scars from the ties that often hold babies in place during feedings in Chinese orphanages. The child seemed evidently engaged, but shockingly small — the size of an 8-month-old, Dr. Aronson’s measurements confirmed.

But the Shihs seemed no longer to be seeking Dr. Aronson’s medical opinion of their son and his prognosis. They were instead showing him off (“Let’s see some walking now!”) while putting up with a routine check-up. Issues that might cause great consternation in biological parents — Paul’s clear signs of low muscle tone and low ratings on the weight chart — seemed to breeze right by the Shihs, even as they took note of how they needed to follow up. Paul nuzzled in his mother’s neck. He fell asleep in his father’s arms.